[Management of arrhythmias during pregnancy: a literature review in light of the Heart Rhythm Society consensus document].

Abstract

Maternal mortality represents a crucial indicator of the quality of care, as stated by the World Health Organization. Non-obstetric mortality in Italy is equally derived from cardiovascular and hypertensive problems with an upward trend. The increased incidence of cardiovascular risk factors, the rise in maternal age, and the use of assisted reproduction suggest a growing impact of arrhythmias on maternal morbidity and mortality. This review article outlines the management of the most common arrhythmias during pregnancy, following the Heart Rhythm Society consensus document. The general principle is that any treatment should not be delayed in urgent situations due to concerns about fetal risk, as restoring sinus rhythm and adequate maternal hemodynamics is the primary objective of therapy. Despite limitations associated with data from non-randomized studies, key antiarrhythmic drugs are relatively safe. Electrical cardioversion is risk-free with certain management peculiarities. When required, ablation therapy or the implantation of intracardiac devices with zero or minimal fluoroscopy can be considered. Clinically significant arrhythmias and the management of patients with structural heart disease or channelopathies require multidisciplinary care in a cardio-obstetric team, with particular attention to delivery setting and timing.